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The idea of pragmatism is controversial and there are doubts about whether pragmatic trials can replace tests for explanations or if they should be an alternative to them. Schwartz and Lellouch1 suggested the distinction between explanation trials, which confirm a physiological or clinical hypothesis as well as pragmatic trials, which guide the policy and practice of. They also suggested a framework known as PRECIS for pragmatic trials.2 This tool attempted to define the traits of a practical study that includes the recruitment, design, and delivery of the intervention and follow-up. The number of pragmatic trials is increasing. A recent Medline search using the terms naturalistic and pragmatic, which was limited to controlled trials randomized to control (RCTs), yielded 34 articles, as shown in red in Figure 2. This is an indication that the health science community is becoming more sensitive to the subject of pragmatic thinking. It is important to remember, however, that the majority of these studies were conducted in primary care settings.